Original Article

Reliability of the Adhesive Remnant Index Score System with

Different Magnifications
Mona A. Montassera; James L. Drummondb
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ABSTRACT
Objective: To test the hypothesis that adhesive remnant index (ARI) scores show no differences
when examined under different magnifications.
Materials and Methods: The study included 80 upper human premolars. Stainless steel brackets
were bonded to the specimens with Transbond XT light cure adhesive and Transbond Plus Self
Etch Primer (3M Unitek, Monrovia, Calif, USA). The brackets were debonded 24 hours after
bonding with a universal testing machine (LLOYD Instruments, Segensworth, Fareham, England)
at a cross head speed of 2.00 mm/min. The adhesive remnant was evaluated after debonding
with the naked eye and under 10⫻ and 20⫻ magnification (Mag) using the 4-point scale described
by Årtun and Bergland.
Results: ARI scores were significantly different at different magnifications (P ⫽ .018). Scores
The Angle Orthodontist 2009.79:773-776.

were not significantly different when evaluated with the naked eye and under 10⫻ Mag (P ⫽
.102). Scores were significantly different under 20⫻ Mag and with the naked eye (P ⫽ .014);
under 20⫻ Mag, score 0 decreased from 12 to 6 and score 2 increased from 14 to 20 and also
under 20⫻ Mag and under 10⫻ Mag (P ⫽ .046); the under 20⫻ Mag score 1 decreased from 40
to 38 and score 3 increased from 14 to 16.
Conclusion: ARI scores were significantly different under 20⫻ Mag, where score 0 decreased
and score 2 increased compared with the naked eye, while score 1 decreased and score 3
increased compared with 10⫻ Mag. (Angle Orthod. 2009;79:773–776.)
KEY WORDS: Adhesive remnant index; Different magnifications

INTRODUCTION pression of the bracket mesh. Over the years, ARI

Årtun and Bergland1 used an Adhesive Remnant In-
dex (ARI) system to evaluate the amount of adhesive
left on the tooth after debracketing. This index system
was developed on the basis of a pilot study of 20 ex-
tracted teeth and the criteria were as follows: score 0
⫽ no adhesive left on the tooth; score 1 ⫽ less than
half of the adhesive left on the tooth; score 2 ⫽ more
than half of the adhesive left on the tooth; and score
3 ⫽ all adhesive left on the tooth with a distinct im-
a
Lecturer, Department of Orthodontics, Faculty of Dentistry,
Mansoura University, Mansoura, Egypt.
b
Professor Emeritus, Department of Restorative Dentistry,
School of Dentistry, University of Illinois at Chicago, Chicago,
Illinois.
Corresponding author: Dr Mona A. Montasser, Orthodontic
Department, Faculty of Dentistry, Mansoura University, Man-
soura, 35516 Egypt
(e-mail: mmontasser11@yahoo.com)
Accepted: October 2008. Submitted: August 2008.
 2009 by The EH Angle Education and Research Foundation,
Inc.
scores have been one of the most frequently evalu-
ated aspects in studies on orthodontic adhesives. Be-
cause the adhesive remnant score system is qualita-
tive and subjective, many attempts have been made
to modify the original system, or to develop new quan-
titative methods that can be used to more accurately
assess the adhesive remnant. To more accurately
evaluate the adhesive remnant qualitatively, many
studies expanded the ARI system that was developed
by Årtun and Bergland1 into 5 or 6 scales.2–6 Studies
such as that of O’Brien et al7 aimed to introduce a
more precise technique for describing the resin rem-
nant; this study used a quantitative method whereby
a magnified image of the enamel is digitized and the
amount of remaining resin is expressed as a percent-
age of bracket base area.
To accurately score the ARI is important because it
is an important factor to be considered in the selection
of orthodontic adhesive. Studies8–11 have debated
whether the differences in ARI scores reflect a differ-
ence in bond strength between the enamel and the

DOI: 10.2319/080108-398.1 773 Angle Orthodontist, Vol 79, No 4, 2009

 774 MONTASSER, DRUMMOND

adhesive for the different adhesive systems, but ad- Table 1. Frequencies of ARI Scores for the 3 Magnificationsa
hesive systems that show less adhesive remnant on ARI Scores
the tooth has been advocated for easier and safer re- N 0 1 2 3
moval of residual resin after debonding.12,13 Accurate
Naked eye 80 12 38 14 16
evaluation of the adhesive remnant, which is crucial in 10⫻ Mag 80 6 40 20 14
the final process of enamel cleaning after debonding, 20⫻ Mag 80 6 38 20 16
is needed for satisfactory removal and restoration of
Chi-square ⫽ 8.089; P ⫽ .018.*
the enamel surface to as close to pretreatment con- a
ARI indicates adhesive remnant index; Mag, magnification.
dition as possible. Most laboratory studies on the bond * Significant at P ⱕ .05.
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strength of orthodontic brackets have examined teeth

and brackets under 10⫻ magnification (Mag) to as-
Table 2. Wilcoxon Signed Ranks Test Comparing the 3 Magnifi-
sess and score the adhesive remnant,3,4,6,10 although
cationsa
laboratory studies designed for evaluation of the
enamel surface after debonding and cleaning of the z Significance
surface have used more sophisticated methods such Naked eye–10⫻ Mag ⫺1.63 .102
as scanning electron microscope, finite element anal- Naked eye–20⫻ Mag ⫺2.44 .014*
10⫻ Mag–20⫻ Mag ⫺2.00 .046*
ysis, and 3-dimensional profilometry.14–16 Clinically,
evaluation of the adhesive remnant and the enamel a
Mag indicates magnification.
surface after bracket debonding and enamel cleanup * Significant at P ⱕ .05.
generally is done by visual inspection under a dental
The Angle Orthodontist 2009.79:773-776.

operating light.
Because of the small surface area of the orthodontic
brackets and thus of the enamel surface area covered
by the adhesive remnant, group gap and overlaps
could appear during evaluation of the ARI. No studies
have attempted to study the effect of magnification on
the reliability of the ARI score system.
The objective of this study was to test the hypoth-
esis that adhesive remnant index (ARI) scores show
no differences when eaminedx under different magni-
fications.
MATERIALS AND METHODS
This study examined 80 human upper premolars ex-
tracted for orthodontic purposes and stored in an
aqueous solution of thymol (0.1% wt/vol). The teeth
were fixed in self-curing acrylic resin placed in plastic
rings of 30 mm diameter with only the buccal surface
exposed and oriented parallel to the bottom of the
mold.
The buccal surface of each tooth was cleaned with
nonfluoridated oil-free pumice paste and then was
rinsed with water and dried with an oil-free air spray.
Upper premolar stainless steel brackets (Mini Twin,
American Orthodontics, Sheboygan, Wis, USA) were
bonded to the specimens with Transbond XT light cure
adhesive and Transbond Plus Self Etch Primer (3M
Unitek, Monrovia, Calif, USA), in keeping with the
manufacturer’s instructions. The specimens were then
stored for 24 hours in distilled water before undergoing
testing at 37⬚C.
A universal testing machine (LLOYD Instruments,
Segensworth, Fareham, England) was used to debond
the brackets at a cross head speed of 2.00 mm/min
with an occlusal-gingival load applied to the bracket,
producing a shear force at the bracket tooth interface.
Evaluation and scoring of the adhesive remnant
were carried out by the same evaluator under the dif-
ferent magnifications chosen for this study. Evaluation
was carried out with the naked eye, under 10⫻ Mag,
and under 20⫻ Mag. The specimens were evaluated
under each magnification in a separate session and
randomly in each session. The ARI evaluation used
the 4-point scale of Årtun and Bergland,5 where 0 in-
dicates no adhesive left on the tooth surface, implying
that bond fracture occurred at the resin/enamel inter-
face; 1 indicates that less than half the adhesive is left
on the tooth surface, implying that bond fracture oc-
curred predominantly at the resin/enamel interface; 2
indicates that more than half the adhesive is left on
the tooth surface, implying that bond fracture occurred
predominantly at the bracket/resin interface; and 3 in-
dicates that all adhesive is left on the tooth surface
with a distinct impression of the bracket base, implying
that bond fracture occurred at the bracket/resin inter-
face.
A Friedman test followed by a Wilcoxon signed
ranks test was used to investigate any significant dif-
ferences in ARI scores between the different magnifi-
cations.
RESULTS
The ARI score distribution for the different magnifi-
cations is shown in Table 1. The results of the Fried-
man test show that the ARI score evaluation was sig-
nificantly different under different magnifications (P ⫽
.018). The Wilcoxon signed ranks test (Table 2) shows
a significant difference when scores were evaluated

Angle Orthodontist, Vol 79, No 4, 2009

 RELIABILITY OF THE ARI SCORE SYSTEM
under 20⫻ Mag and with the naked eye (P ⫽ .014);
under 20⫻ Mag, the number of score 0 decreased
from 12 to 6, and the number of score 2 increased
from 14 to 20. ARI scores were also significantly dif-
ferent when evaluated under 20⫻ Mag and under 10⫻
Mag (P ⫽ .046); under 20⫻ Mag, the number of score
1 decreased from 40 to 38, and the number of score
3 increased from 14 to 16. ARI scores were not sig-
nificantly different when evaluated with the naked eye
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and under 10⫻ Mag (P ⫽ .102).
DISCUSSION
The ARI score system has proved to be of value in
studies of orthodontic adhesive systems. It is a quick
and simple method that needs no special equipment.
However, its reliability requires investigation, with spe-
cial attention on the effects of magnification on eval-
uation of the adhesive remnant. The results of this
study show that there was a significant difference be-
The Angle Orthodontist 2009.79:773-776.
tween ARI scores when the evaluation was done at
different magnifications. A significant difference be-
tween scores can be seen when evaluation was done
with the naked eye and under 20⫻ Mag. Changes in
scores were noted mainly in 2 areas: score 0 and
score 2. Under 20⫻ Mag, the number of score 0 de-
creased from 12 to 6, and the number of score 2 in-
creased from 14 to 20. A significant difference be-
tween scores was also evident when evaluation was
done under 10⫻ Mag and under 20⫻ Mag. Under 20⫻
Mag, the number of score 1 decreased from 40 to 38,
and the number of score 3 increased from 14 to 16.
Generally, under the higher (20⫻) magnification, there
was a tendency for the lower scores to decrease and
the higher scores to increase as compared with the
lower (naked eye and 10⫻) magnifications. An inter-
esting result was that no significant difference was
seen between ARI scores when evaluation was done
with the naked eye and under 10⫻ Mag. Differences
in the number of the scores in the 2 groups were not-
ed, but statistically, these differences were insignifi-
cant. This indicates that there is no evidence to sup-
port the assumption made in most of the papers on
orthodontic adhesives that included an evaluation of
the ARI scores—that evaluation of ARI scores under
10⫻ Mag is more accurate than evaluation of these
scores with the naked eye.
Studies targeting the reliability of the ARI score sys-
tem are not common. In his study on the bond strength
of orthodontic brackets, Oliver17 examined the reliabil-
ity of the system and found that interobserver and in-
traobserver variability is low when the system is used,
but the reliability was evaluated under the same mag-
nification. David et al18 evaluated the accuracy of the
ARI score system compared with quantitative mea-
775
surements; this study compared the system as de-
scribed by Årtun and Bergland1 and by Bishara and
Trulove,19 wherein ARI scores were designed from 0
to 3 and from 1 to 5, respectively, vs a quantitative
method wherein the area covered with the adhesive
remnant was measured from photographs with a sonic
digitizer and a linear magnification factor of 30.8⫻.
Graphs representing qualitative scores and quantita-
tive measurements converted to percentages showed
that the qualitative methods currently used to assess
the amount of remnant adhesive left on the enamel
surface after debonding did not closely reflect the
quantitative area measurement of the remnant adhe-
sive. Investigators concluded that the quantitative
methods are preferable if accurate evaluation of the
adhesive remnant is required. However, quantitative
evaluation of the adhesive remnant is more sophisti-
cated, requires special equipment, and is more time
consuming than qualitative evaluation, and it is espe-
cially difficult to apply clinically.
A higher magnification may offer a way to perform
more accurate evaluation of the adhesive remnant, but
further investigation is needed to reach a standard
magnification.
CONCLUSIONS
• The original hypothesis was rejected; the statistics
showed significant differences when ARI scores
were evaluated under different magnifications.
• At higher (20⫻) magnification, the tendency is for
lower scores to decrease and higher scores to in-
crease as compared with lower (naked eye and
10⫻) magnifications.
• Under 20⫻ Mag, score 0 decreased from 12 to 6,
and score 2 increased from 14 to 20 compared with
naked eye scores; also, score 1 decreased from 40
to 38 and score 3 increased from 14 to 16 compared
with 10⫻ Mag scores.
ACKNOWLEDGMENTS
Special thanks to the manufacturers 3M Unitek and American
Orthodontic for supplying the materials for this study.
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